Skin flaps in periorbital reconstruction.

Soft tissue defects of the periorbital region are best repaired with local skin or skin-muscle flaps. Flaps have functional and aesthetic advantages over skin grafts in that they provide a better color and texture match to the thick periorbital skin. The general physiological and biomechanical principles of skin flap survival and orientation are discussed with modification according to peculiarities of the periorbital area. The four basic groups of skin flaps are the sliding flap, advancement flap, rotation flap, and transposition flap. Selected standard and modified designs of each group are illustrated, and each surgical technique is described in stepwise fashion. The specific applications of the flaps to periorbital reconstruction are emphasized. The indications for use of various skin flaps, the local factors involved in flap selection, and proper preoperative planning are also discussed.